Disability support and services in Australia

16 June 2008

Janet Phillips
Social Policy Section

Introduction

Commonwealth, state and territory governments share the responsibility for providing disability support services in Australia. Governments also provide a range of mainstream services that indirectly impact on people with disabilities, for example, various health programs. This mix of mainstream and disability-specific services at the local and federal level makes it difficult to get a clear picture of disability support, funding and services across the country.

This Background Note provides an overview of government provided disability support and services in Australia. It includes background on Commonwealth, state and territory responsibilities, legislation and funding and provides links to some key national and international organisations in the disability area. It reviews and updates the contents of Disability support and services in Australia.[1]

Disability is not easily defined, but it is generally accepted to be a condition that limits an individual s ability to carry out day to day activities. The level of severity of a disability may vary from mild (for example, the need to wear glasses) to severe (for example, some forms of brain injury).

The Productivity Commission s Report on Government Services 2008 lists several of the commonly accepted definitions of disability from sources that include the World Health Organisation (WHO), the Australian Bureau of Statistics (ABS) and the Commonwealth State Territory Disability Agreement (CSTDA):

The International Classification of Functioning, Disability and Health defines disability as being an experience for the person involved that may include the impairment of their body structure and function, limitation of their activity and restriction of their participation in life areas. The International Classification of Functioning, Disability and Health also recognises the role of physical and social environmental factors in affecting disability (WHO 2001).

The Australian Bureau of Statistics (ABS) Survey of Disability, Ageing and Carers (SDAC) was conducted in 1981, 1988, 1993, 1998 and 2003, and was based on the International Classification of Functioning, Disability and Health and its predecessor. The 2003 survey defined a disability as a limitation, restriction or impairment that has lasted, or is likely to last, for at least six months and restricts everyday activities. Self care, mobility and communication are defined as core activities. The ABS defines levels of core activity limitation as follows:

mild where a person does not need assistance and has no difficulty with self care, mobility and/or communication, but uses aids or equipment

moderate where a person does not need assistance, but has difficulty with self care, mobility and/or communication

severe where a person sometimes needs assistance with self care, mobility and/or communication tasks; has difficulty understanding or being understood by family or friends; or can communicate more easily using sign language or other non-spoken forms of communication

The CSTDA (2003, p. 9) defines people with disabilities as those whose disability manifests itself before the age of 65 years and for which they require significant ongoing and/or long term episodic support. For these people, the disability will be attributable to an intellectual, psychiatric, sensory, physical or neurological impairment or acquired brain injury (or some combination of these) which is likely to be permanent and results in substantially reduced capacity in at least one of the following:

self-care/management
mobility
communication

Source: ABS (2004c); WHO (2001); CSTDA (2003).

It is worth noting that the Commonwealth government uses varying definitions of disability or impairment for different purposes. In relation to the disability related payments provided by the Commonwealth government, the Commonwealth has developed specific definitions rather than relying on the broader, internationally accepted definitions of disability, handicap or impairment. For example, individuals (over the age of 16) are considered eligible for the Commonwealth Disability Support Pension if they have an illness, injury or disability that stops the individual from being able to work or be retrained for work of at least 15 hours per week at full-award wages within the next two years. The illness, injury or disability must also attract an impairment rating of at least 20 points on the impairment tables contained in the Social Security Law. To be eligible for the Carer Payment (Adult) the person being cared for must be aged 16 or over with a 'severe disability or medical condition' as assessed by a health professional.

The most recent survey, conducted in 2003, found that one in five people in Australia (3.9 million or 20 per cent) had a reported disability. This rate was much the same for males (19.8 per cent) and females (20.1 per cent). The survey found that there was little change in the disability rate between 1998 (20.1 per cent) and 2003 (20 per cent). The rate of profound disability also showed little change between 1998 (6.4 per cent) and 2003 (6.3 per cent).

The findings included:

One in five people in Australia, or 20 per cent, had a reported disability in 2003. A further 4.1 million, or 21 per cent, had a long-term health condition that did not restrict their everyday activities.

Of those with a reported disability, 86 per cent (3.4 million) had a specific limitation or restriction that is, were limited in the core activities of self care, mobility or communication, or restricted in schooling or employment. Most people with a disability (76 per cent) were limited in one or more of these core activities.

The labour force participation rate of persons with a disability was 53 per cent and the unemployment rate was 8.6 per cent. Corresponding rates for those without a disability were 81 per cent and 5.0 per cent.

The median gross personal income per week of persons aged 15 64 years with a reported disability living in households was $255, compared to $501 for those without a disability. Median gross personal income per week decreased with increasing severity of disability. It was lowest ($200 per week) for those with a profound core-activity limitation.

The Commonwealth first became directly involved with providing support for people with disabilities with the introduction of the Invalid Pension in 1908. The current version of this benefit is the Disability Support Pension.

During the 1940s the number of people with disabilities increased rapidly essentially due to injuries suffered during the Second World War. In response to this, the Commonwealth established the Commonwealth Rehabilitation Service (CRS) and expanded the number of sheltered workshops and accommodation services run by volunteer organisations. Through the 1960s and 1970s the Commonwealth increasingly provided funding to help these organisations provide accommodation, employment and other support services.

In the 1980s, there was a general move by service providers away from institutional service provision towards more community orientated service provision. The introduction of the first International Year of Disabled Persons in 1981 further enhanced an increasing awareness in the community of the difficulties faced by people with disabilities. One of the main aims of the International Year was to remove the barriers preventing disabled people from achieving equality with able bodied people.

Following the International Year of Disabled Persons a range of initiatives was introduced that had implications for the provision of support and services for people with disabilities. The most important of these were:

The introduction of the Disability Services Act 1986 which provided a comprehensive framework for the funding and provision of disability support services.

The 1991 Disability Reform Package which reformed Commonwealth income support payments for people with disabilities with a view to encouraging integration into the workforce.

The signing of the first Commonwealth State Disability Agreement (CSDA) in 1991 which aimed to clarify the roles and responsibilities of the governments. The Commonwealth was given responsibility for income support and employment services and the States and Territories were given responsibility for accommodation and other support services. A major aim of the CSDA was to reduce the amount of duplication and administrative complexity that existed in the funding and service arrangements for disabled people. Since then, there have been two agreements 1998 and 2002 with the fourth due in 2008.[2]

The Disability Discrimination Act 1992 which aims to eliminate discrimination against people with disabilities; ensure equality before the law and promote acceptance within the community of the fundamental rights of people with disabilities.

...a framework for national reform from an institutionally based mental health system to one that is consumer focused with an emphasis on supporting individuals in their community. The Strategy was reaffirmed in 1998 with the Second National Mental Health Plan and again in 2003 with the endorsement of the National Mental Health Plan 2003-2008.[3]

The introduction of the 1994 Commonwealth Disability Strategy (CDS) to assist Australian Government agencies meet their obligations under the Commonwealth Disability Discrimination Act 1992 see below for more detail.

Commonwealth State Territory Disability Agreement (CSTDA)

The Commonwealth State Territory Disability Agreement (CSTDA) provides the national framework for the delivery, funding and development of specialist disability services for people with disabilities. It is the main vehicle in Australia providing disability services to those in need. The Commonwealth s main areas of responsibility in this area include:

most disability related payments and allowances

the provision of employment services for people with disabilities and

some generic services and support (such as rehabilitation and various health programs).

The states and territories are responsible for most other areas of support including:

accommodation

community access services

respite care and

disability related support in schools.

Some areas are shared between the Commonwealth and the states such as health funding and the Home and Community Care Program (HACC).

There have been three agreements so far 1991, 1998 and 2002 with the fourth due in 2008. The current (third) CSTDA agreement came into force in mid 2003 and was due to expire in June 2007. However, the Commonwealth, state and territory governments agreed to an extension to 31 December 2007 to enable negotiations for a fourth CSTDA to be finalised. In January 2008, the new Minister, Jenny Macklin, announced that the agreement would be extended to 30 June 2008 to allow time for renegotiations with the new government:

The Australian Government will provide over $315 million, to be paid fortnightly in advance, to State and Territory Governments to continue services for people with disability while allowing time for the effective renegotiation of a new disability agreement.[5]

In February 2008, the federal and state and territory disability ministers met in Melbourne for preliminary discussions and agreed to meet again in March to renew negotiations.[6] See the Communiqu for outcomes of the February discussions.

Data from the Services for people with a disability section of previous reports shows that in terms of the total expenditure on disability services by the Commonwealth and states and territories, there has been a steady rise in funding in real terms over recent years. The latest Report on Government Services, (2008), shows that in 2006 07, total government expenditure on CSTDA funded services was $4.3 billion. This equates to percentage increases in total real expenditure on services by the Commonwealth and the states and territories of 6.7 per cent on the 2005 06 expenditure of $4.1 billion.

In 1994, the Commonwealth Disability Strategy (CDS) was introduced to assist Commonwealth Government agencies meet their obligations under the Commonwealth Disability Discrimination Act 1992. The CDS was intended to encourage Australian Government departments to ensure equal access for people with disabilities in the development and delivery of policy, programs and services.

An independent evaluation of the CDS, Evaluation of the Commonwealth Disability Strategy, (the Erubus report), was conducted in 2005 06.[8] The evaluation recommended the continuation of the CDS, but identified a need to further develop the strategy to ensure its continued effectiveness.

In response to the Erubus report, the Howard government embarked on a review of the CDS:

...the department has been undertaking a series of discussions on the way forward with the CDS, consistent with the themes in the evaluation. We have had discussions with the federation of disability organisations. Minister Scullion, through Minister Brough, has asked for some advice from the National Disability and Carers Advisory Council on ways in which to give effect to some of the recommendations in the Erebus report. Some of the key themes in the report were that the reporting required under the current CDS is largely process and compliance driven, rather than outcome based. We have been negotiating with the sector as well as with the Australian Public Service Commission on ways in which we can make that reporting more meaningful. We have also been talking to the sector about ways in which the sector may be involved more in an educative role with Commonwealth agencies around how best they can give effect to their responsibilities under the CDS. That information is feeding into advice to the minister, but a decision on the formal way forward from government has not been taken at this stage.[9]

In the ALP Disability and Carers 2007 election policy document, Mr Rudd announced that if elected, there would be a new National Disability Strategy negotiated with the states and territories to tackle the complex needs of people with disabilities and their carers . This was reinforced in the Communiqu from the federal and state and territory disability ministers meeting in Melbourne on 1 February 2008, where the Minister, the Hon. Jenny Macklin, MP, stated that:

...the development of the Australian Government's National Disability Strategy...will provide leadership in disability policy and draw on the experience of States and Territories. The National Disability Strategy is an historic opportunity for the Commonwealth, States and Territories to work together with the community to ensure the needs of people with disabilities and their families are addressed through coordinated and comprehensive policy planning - across all Government Departments and services.

The NDS will provide an overarching policy statement and action framework, setting out the national view, directions and priorities for the development of legislation and policy. This will include action plans for service delivery, policy development, quality assurance and a research agenda that is informed by state, territory and international experience.

The NDS will include the development of the Harmonisation of Accessible Parking Schemes initiative. This will provide an integrated national approach to support greater participation of drivers with disability and eligible carers in the community through improved access to parking options.

At this point it is not clear how the NDS will differ from the previous strategy. However, the CDS website currently indicates that:

The NDS will cover already existing approaches by the Commonwealth, states and territories, acknowledging and supporting the priorities of existing strategies that address disability issues.

The CDS is an example of an existing strategy that will perform a significant role as an integral element within the new NDS that will serve to focus the attention of Commonwealth Government agencies on meeting their obligations under the Disability Discrimination Act 1992.

In the 1 February 2008 Communiqu , the Minister outlined other developments planned in the area of disability:

The National Disability Strategy and the CSTDA 4 are also vehicles through which Ministers can work together on the eight key priority areas identified by Labor at the election:

*Better measurement of current and future need for disability services;

*Moving toward national population benchmarks for key disability service types;

*Making older carers a priority for all disability services under the CSTDA;

*Quality improvement systems based on the National Disability Service Standards for all Agreement services;

*Improved service planning and strategies to simplify access to services under the CSTDA;

*Focusing on early intervention, lifelong planning and increasing the independence and social participation of people with a disability;

Employment support: funding to organisations to provide employment services as well as the direct provision of employment and training programs. See FAHCSIA s employment for people with a disability page and Centrelink s disability employment services page. The Australian Human Rights Commission (AHRC) website includes a page on disability employment issues.

Rehabilitation: provision of services and support through the Commonwealth Rehabilitation Service (CRS). The CRS assists people with an injury or disability via work related rehabilitation programs under the Disability Services Act 1986. CRS operates within the Department of Human Services and is the largest provider of Government funded vocational rehabilitation services.

Accommodation: provision of funding to the states and territories for accommodation support, respite, independent living and recreation services.

The shift in emphasis in recent years from institutional care towards ageing at home and community care has seen the role of carers become even more important in our community. It is estimated that there are over 2.5 million carers supporting people with disabilities (or the elderly) in Australia, of which about 474 600 are primary carers (an individual providing the primary care for the person requiring support).[10]

The Commonwealth provides support for carers through the CSTDA by contributing additional funding to help the states and territories pay for their responsibilities, including responsibilities for respite care. Outside of the CSTDA, the Commonwealth provides other support for carers and for respite care. For example, apart from the two main carer income support or income supplement payments (Carer Payment and Carer Allowance), the Commonwealth also funds Commonwealth Carer Resource Centres and Commonwealth Carer Respite Centres.

The Home and Community Care Program (HACC) commenced in 1985 and is a joint Commonwealth/State program designed to provide services which support people living at home who are at risk of inappropriate admission to institutional care. It is administered in accordance with agreements signed between the Commonwealth and all states and territories. The aims of the program are to provide support services for the frail aged, people with a disability and their carers; to help these people to be more independent at home and in the community and to ensure that there is flexible service provision that responds to the needs of the user.

The types of services provided under HACC include home help, personal care, home nursing, home respite, centre day care, home meals, transport and home maintenance and modification. Changing government policies over the past ten years or so has seen a shift way from the more intensive care programs related to the residential aged care sector (notably nursing homes) towards home based care including HACC and Community Aged Care Packages.

Community Aged Care Packages (CACPs) and Extended Aged Care at Home (EACH) packages provide an alternative to residential aged care and allow the elderly to stay in their home or similar environment. Both these packages are solely funded by the Commonwealth. CACPs provide support and care for people assessed as being in need of low level (hostel) type care and the EACH packages are designed for those assessed as requiring high level (nursing home) care.

All three of the main community options listed above do allow some respite for carers and enable the provision of various health and home support to be brought into the disabled person s home.

The 2007 Australian Institute of Health and Welfare report, Current and Future Demand for Specialist Disability Services, found that in 2005 there were 23 800 people aged 0 to 64 in Australia with unmet or under met need for accommodation and respite services. The report also projects that by 2010 there will be 752 000 people with a profound disability, an increase of 4.8 per cent or 34 600 from the estimated figure in 2006.

...although public rhetoric acknowledges the need to help carers of the aged and people with a disability to balance their work and caring responsibilities, in reality tangible support is insufficient and ineffective. This is evident in relation to public policy e.g. legislation, financial support and service provision.[11]

There is general acceptance that there is a significant problem of unmet need with respect to the provision of support and assistance for people with disabilities. The 1998 ABS Survey of Disability, Ageing and Carers found 24 000 people with a profound or severe disability and more than 41 000 primary carers who received no assistance at all.

The most recent survey, the 2003 ABS Survey of Disability, Ageing and Carers, had similar findings. It found 28 000 people with a profound or severe disability receiving no assistance at all, and:

Of those with a core-activity limitation, the more severe the limitation, the higher the proportion with an unmet need for help. Of those with a profound limitation 50 per cent reported that their needs were only partly met or not met at all. This contrasts with 41 per cent for those with a severe limitation, 26 per cent for those with a moderate limitation and 16 per cent for those with a mild limitation who reported that their needs were partly met or not met at all.[12]

There have been several reports analysing unmet need in disability services in recent years:

In 2002, AIHW completed a major study into the unmet need issue, Unmet Need for Disability Services. It found that despite some additional funding being added via the CSTDA at the time (for example, the Commonwealth and the states allocated approximately $500 million over the 2000 02 period for unmet need) in 2001, there were over 12 000 people still in need of accommodation and respite services and over 5000 people needing employment support.

The main Commonwealth legislation covering the rights of people with a disability is the Disability Discrimination Act 1992 and the main Commonwealth body that is charged with protecting the rights of disabled people and advocating on their behalf is the Australian Human Rights Commission (AHRC)—previously known as the Human Rights and Equal Opportunity Commission (HREOC). For more background on the Commission and disability rights and advocacy see the AHRC disability rights page. The Attorney-General s Department provides legal and policy information on matters arising under the Disability Discrimination Act 1992 (DDA).

The Disability Services Act 1986 outlines arrangements for the provision of services for people with disability and aims to assist persons with disabilities to receive services necessary to enable them to work towards full participation as members of the community .

HREOC Disability standards and guidelines website outlines standards that are associated specifically with the Disability Discrimination Act (these are not necessarily the same as the National Disability Standards):

Under the Disability Discrimination Act (DDA), the Attorney-General may make Disability Standards to specify rights and responsibilities about equal access and opportunity for people with a disability, in more detail and with more certainty than the DDA itself provides. The Commission has a function of advising the Attorney on making such standards. Standards can be made in the areas of employment, education, public transport services, access to premises, accommodation and the administration of Commonwealth laws and programs...

The National Disability Service Standards are made under the Disability Services Act 1986 and apply to all service types funded through the CSTDA. These standards complement the provision of services for people with disability under the Commonwealth Disability Services Act 1986 and the Disability Discrimination Act 1992, along with related Australian legislation such as laws relating to discrimination, guardianship provisions, equal employment opportunity, occupational health and safety, and freedom of information. Under the CSTDA, the core quality standards applicable to all services receiving funding under this agreement are the National Standards.

UN Convention: The Government has proposed that Australia ratify the United Nations Convention on theRights of Persons with Disabilities and has invited NGOs and industry representatives to participate in consultations on Australia s commitment to the convention. [17]

Carer payment: The Minister has released a report by the Carer Payment (child) Review Taskforce, which examines the effectiveness of support to carers of children with a severe disability or medical condition.[18] Note: the 2008 09 Budget provides for a new Carer Payment assessment process that will result in a considerable relaxation of the eligibility criteria. The new criteria will see greatly expanded access to Carer Payment for those caring for children.[19]

National Mental Health and Disability Employment Strategy: The Rudd Government announced a new strategy in February 2008 to assist people with a disability find and retain employment.[20]

Disability employment: The Department has invited eligible organisations to submit their expressions of interest to establish new disability supported employment business services in areas where there is demonstrated high demand. There are 250 supported employment places available across Australia.

Autism strategy: On 3 October 2007, the then Prime Minister, announced details of the Australian Government's autism package, Helping children with autism, delivering $190.7 million in new funding over five years. A number of initiatives will be implemented nationally by the Departments of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA), Health and Ageing (DoHA), and Education, Employment and Workplace Relations (DEEWR). FaHCSIA will oversee the implementation of the following initiatives:

Education and support for families and carers of children aged 0 to 6 with autism spectrum disorders and

Increased access to early intervention programs for children aged 0 to 6 with autism spectrum disorders.

Disability investment group: The Australian Government has established a Disability Investment Group to explore funding ideas from the private sector to help people with disabilities.

Data: The Commonwealth may insist in future on better data reporting from the states and territories. The FaCSIA CSTDA Annual Reports were an attempt in the past to achieve this. Australian, State and Territory Governments are required to collect program, service and consumer data known as the National Minimum Data set as part of the Commonwealth State Territory Disability Agreement (CSTDA). See the Disability Services Census page.

Accommodation: this is an ongoing issue and responsibilities and funding are under review by the Commonwealth, states and territories. In its Disability and Carers 2007 election policy, the ALP promised to provide $962 million in funding for disability services, currently outside the CSTDA, back into the agreement on a dollar for dollar matching basis with the states and territories as part of the renegotiated CSTDA agreement In a statement on the Department s website in February 2008, the Minister, the Hon. Jenny Macklin, indicated that this funding was related to accommodation services:

A renegotiated agreement is a priority for our government and will bring over $900 million of Commonwealth funding allocated for accommodation, respite and in-home support back into the CSTDA. [21]

The 2008 09 Budget provides further confirmation that this redirection of funds over four years is referring to funding previously allocated for the provision of accommodation support services through the Commonwealth s Disability Assistance Package.[22]

Young people in nursing homes: states and territories have been attempting to create more appropriate housing options for young people with a disability in nursing homes in recent years (currently about 6000 people). In February 2006, COAG announced that the Australian government and states and territories had agreed to provide joint funding of up to $244 million for a five year program managed by the states and territories. The funding provided age appropriate care for younger people with disabilities currently in residential aged care and aims to reduce the overall numbers of people in such facilities. In February 2007, the then Minister, the Hon. M. Brough, announced that all States and Territories have now signed bilateral agreements with the Australian Government to help young people with a disability move out of residential aged care facilities. [23] The national industry association, National Disability Services, met with Parliamentary Secretary for Disabilities and Children s Services, the Hon. Bill Shorten, on 20 March 2008 to discuss the progress of this initiative. For more detail see the Young People in Nursing Homes Alliance website and the AHRC disability accommodation page.

[2]. Note: although part of the agreement from the outset, the territories were only acknowledged in the title for the first time in 2002 when the CSDA became known as the Commonwealth State and Territory Disability Agreement (CSTDA).

[7]. For more details on Commonwealth, state and territory funding, statistics on disability support and jurisdictional responsibilities see the disability section and attachments in the Report on Government Services (Productivity Commission, 2008) and the Commonwealth Grants Commission 2008 Working Paper on aged and disabled.